Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 23060000978 | VA |
NPI | 1013111756 |
---|---|
Provider Name | Ms. Sandra Bowman |
First Address | Chesterfield, VA 23838-5933 |
Second Address | Richmond, VA 23223-3912 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/06/2007 |
Last Update Date | 08/07/2007 |